Evaluation of integrated disease surveillance and response (IDSR) core and support functions after the revitalisation of IDSR in Uganda from 2012 to 2016

Abstract

BackgroundUganda is a low income country that continues to experience disease outbreaks caused by emerging and re-emerging diseases such as cholera, meningococcal meningitis, typhoid and viral haemorrhagic fevers. The Integrated Disease Surveillance and Response (IDSR) strategy was adopted by WHO-AFRO in 1998 as a comprehensive strategy to improve disease surveillance and response in WHO Member States in Africa and was adopted in Uganda in 2000. To address persistent inconsistencies and inadequacies in the core and support functions of IDSR, Uganda initiated an IDSR revitalisation programme in 2012. The objective of this evaluation was to assess IDSR core and support functions after implementation of the revitalised IDSR programme.MethodsThe evaluation was a cross-sectional survey that employed mixed quantitative and qualitative methods. We assessed IDSR performance indicators, knowledge acquisition, knowledge retention and level of confidence in performing IDSR tasks among health workers who underwent IDSR training. Qualitative data was collected to guide the interpretation of quantitative findings and to establish a range of views related to IDSR implementation.ResultsBetween 2012 and 2016, there was an improvement in completeness of monthly reporting (69 to 100%) and weekly reporting (56 to 78%) and an improvement in timeliness of monthly reporting (59 to 93%) and weekly reporting (40 to 68%) at the national level. The annualised non-polio AFP rate increased from 2.8 in 2012 to 3.7 cases per 100,000 population < 15 years in 2016. The case fatality rate for cholera decreased from 3.2% in 2012 to 2.1% in 2016. All districts received IDSR feedback from the national level. Key IDSR programme challenges included inadequate numbers of trained staff, inadequate funding, irregular supervision and high turnover of trained staff. Recommendations to improve IDSR performance included: improving funding, incorporating IDSR training into pre-service curricula for health workers and strengthening support supervision.ConclusionThe revitalised IDSR programme in Uganda was associated with improvements in performance. However in 2016, the programme still faced significant challenges and some performance indicators were still below the target. It is important that the documented gains are consolidated and challenges are continuously identified and addressed as they emerge.

Cost Analysis of Health Facility Electronic Integrated Disease Surveillance and Response in One District in Sierra Leone

“…Future research should examine the benefits of eIDSR in Sierra Leone, as establishment of eIDSR is expected to improve data timeliness, completeness, quality, and access, [4][5][6]18 but these have yet to be assessed. Additionally, costsaving opportunities should be explored, such as alternative mobile device management solutions.…”

“…This study estimates costs to expand an established electronic system, health facility eIDSR, to a new district and is the first estimation of operational costs needed to sustain eIDSR. As use of electronic platforms to perform IDSR reporting and analysis becomes more popular, [4][5][6] understanding the costs to roll out the system is valuable to Sierra Leone and other IDSR implementers.…”

“…7,14,15 Evaluations of eIDSR systems in other countries have noted financial challenges, such as internet data and infrastructure, especially when health facility staff must use personal phones and cellular data. [4][5][6] In Sierra Leone, tablets and cellular data are provided to health facility staff, but funding has come from donors following the Ebola outbreak. The government of Sierra Leone could consider future funding opportunities to sustain eIDSR and decrease dependence Health facility eIDSR costs should be considered against the country's needs, current health expenditures, and the global perceived benefits of a functional real-time surveillance system.…”

“…3 Use of electronic tools to conduct IDSR (eIDSR) reporting and analysis is increasing and has been reported to improve timeliness, completeness, and availability of data. [4][5][6] Economic costs of IDSR have been assessed in Burkina Faso, Eritrea, and Mali. 7 However, no evaluations have assessed costs associated with electronic IDSR (eIDSR).…”

Electronic Reporting of Integrated Disease Surveillance and Response: Lessons Learned from Northeast, Nigeria, 2019.

“…These support functions included training, provision of case de nitions, reporting tools, and android phones might have contributed to the improvement in the reporting. Experiences shared from Uganda among participants at a focus group discussion showed that training on IDSR at the operational levels led to the improvement in the completeness and timeliness of reporting, case detection, and data analysis [23,24]. Timeliness and completeness are two critical complementary performance indicators of the IDSR strategy.…”